CLINICAL CASE CLINICAL CASE

Product : RAD-GUIDE

Subject :Multiple radiofrequency (RF) renal tumor ablation with the RAD-GUIDE

Description : High risk surgery patient with 3 renal masses referred for percutaneous ablation.

White arrows show lesions on pre-ablation CT performed without contrast.

Description of the intervention

1 2 3

Lesion 1 is an undetermined 7 mm

nodule better seen on post-contrast

images.

Lesion 2 is a solid mass. Lesion 3 is a complex mass.

Two RAD-GUIDEs were necessary to support RF and biopsy needles in adequate orientation.

RAD-GUIDEs are seen in blue (white arrows) and 3 RF needles (black arrows).

January, 2010TM

Discussion This case illustrates the usefullness of the RAD-GUIDE

reach a deep target. The long needle had to be deeply inserted from the beginning because it

would not have entered into the CT gantry.

1

3

2

I ma ges d escrip t ion s

1- 20 cm needle was first inserted with adequate

orientation (black arrow).

2- Needle mov ed forward to reach the abcess.

3- Guidewire inserted (not shown), top plate and

needle remov ed (white arrow) and catheter inserted

over the wire. The abcess completely drained

(black arrow).

to support a long needle and directly

COPYRIGHT © 2011. CIVCO IS A REGISTERED TRADEMARK OF CIVCO MEDICAL SOLUTIONS. RAD-GUIDE IS A TRADEMARK OF CIVCO. PATENTS PENDING.

ALL PRODUCTS MAY NOT BE LICENSED IN ACCORDANCE WITH CANDADIAN LAW. PRINTED IN THE U.S.A.

800.445.6741 | 877.329.2482 | WWW.CIVCO.COM

CLINICAL CASE CLINICAL CASE

Description of the intervention

Discussion :

heavy RF needles in renal masses. The RAD-GUIDE also supported 2 biopsy

needles. A sixth needle was also inserted in the lower RAD-GUIDE in order to inject

CO and dextrose to displace and avoid burning the colon.2

First RF needle. Second RF needle. Third RF needle

RAD-GUIDE (white arrow) supporting a needle used to

inject CO between the colon and the lesion (red arrow).

The use of 2 RAD-GUIDEs was necessary to insert precisely and support 3 long and

2

Product : RAD-GUIDETM

Subject : Deep abdominal abcess drainage with the RAD-GUIDE

Description : 57 Y.O. patient with previous percutaneous abcess drainage secondary to an

abdominal surgery. A second collection was considered too deep for percutaneous

drainage and treated with antibiotics. Patient came back with fever and abdominal

pain.

Diagnostic CT : White arrows show the residual abcess

Description of the intervention

Description of the intervention

Reference grid on patient's skin for choosing

entry point.

The red line drawn on CT monitor helps you to

choose the appropriate hole in the plate of the

RAD-GUIDE to easily reach the abcess.

June, 2010

CLINICAL CASE CLINICAL CASE

Product : RAD-GUIDETM

Subject : CT guided mediastinal mass biopsy with the RAD-GUIDE

Description : Patient with a right lower lobe pulmonary nodule and subcarinal adenopathy.

Histologic diagnostic was necessary and subcarinal mass biopsy was considered

Pre Biopsy CT

A yellow line is drawn from the mass

through the skin entry point (identified

by the freezing needle) and beyond the

the RAD-GUIDE to choose the best hole

in the top plate (curved white arrow).

Reference grid on patient's skin to choose

the best entry point to reach the subcarinal

mass (white arrow). The best path is to

avoid going through the lung (yellow line).

However, space is minimal along the

June, 2010

vertebral body.

easier and safer than getting samples from the small (1 cm) pulmonary nodule.

Description of the intervention

Discussion : The RAD-GUIDE supported a long biopsy needle which usually would have to be

deeply inserted before it stays still, especially in fat. This case illustrates the capacity

for the RAD-GUIDE to save you time by avoiding multiple needle repositioning. It

also gives you different and often safer approaches because any angulated

approches are made not only possible but even easy.

3 4 5

After freezing and choosing the hole

in the top plate, the guiding needle

is moved forward and supported by

the RAD-GUIDE (white arrow).

The long guiding needle is moved

forward until reaching the

adenopathy. Top plate was

dropped down allowing to easily

angulate the needle (white arrow).

Coaxial biopsy needle inserted

for adenopathy biopsy

(white arrow).

CLINICAL CASE CLINICAL CASE

Description of the intervention

Discussion: This case shows the advantage of injecting saline to create a pseudo-space and avoid

entering the lung with the risk of pneumothorax. The RAD-GUIDE

needle position during needle movements and saline injection.

The guiding needle is mov ed forward in the

paravertebral space. Saline is injected to

displace the pleural space and the lung.

Saline is seen also dissecting posteriorly

(white arrow). This injection creates a secure

straight path from skin to target. Guiding

needle will not be long enough to reach

mass (yellow arrow).

Coaxial trocart needle is introduced in the

guiding needle. Top plate of the RAD-GUIDETM

is dropped down (yellow arrow) allowing to

reach the mediastinal mass (white arrow).

allows a straight path and stable

Product : RAD-GUIDE

Subject : CT guided retroperitoneal biopsy with the RAD-GUIDE.

Description : Patient with history of bladder cancer with CT diagnostic of retroperitoneal

adenopathy suspicious for cancer recurrence. Percutaneous biopsy was requested

and CT was considered the best modality for the intervention.

CT approaches for biopsy

1

2

Prone CT before biopsy showing a retroperitoneal

adenopathy (long white arrow) adjacent to the IVC (short

white arrow). Standard approach would be paraspinal

increased risk of bleeding.

White line shows the standard vertical approach. Yellow line

shows an easy alternativ e approach with the RAD-GUIDE

which almost only goes through fat . The RAD-GUIDE will

support adequately the long biopsy needle.

June, 2010TM

vertical through muscles, possibly more painful and with

CLINICAL CASE CLINICAL CASE

Description of the intervention

Discussion: This case shows the advantage of injecting saline to create a pseudo-space and avoid

entering the lung with the risk of pneumothorax. The RAD-GUIDE

needle position during needle movements and saline injection.

The guiding needle is mov ed forward in the

paravertebral space. Saline is injected to

displace the pleural space and the lung.

Saline is seen also dissecting posteriorly

(white arrow). This injection creates a secure

straight path from skin to target. Guiding

needle will not be long enough to reach

mass (yellow arrow).

Coaxial trocart needle is introduced in the

guiding needle. Top plate of the RAD-GUIDETM

is dropped down (yellow arrow) allowing to

reach the mediastinal mass (white arrow).

allows a straight path and stable

Product : RAD-GUIDE

Subject : CT guided retroperitoneal biopsy with the RAD-GUIDE.

Description : Patient with history of bladder cancer with CT diagnostic of retroperitoneal

adenopathy suspicious for cancer recurrence. Percutaneous biopsy was requested

and CT was considered the best modality for the intervention.

CT approaches for biopsy

1

2

Prone CT before biopsy showing a retroperitoneal

adenopathy (long white arrow) adjacent to the IVC (short

white arrow). Standard approach would be paraspinal

increased risk of bleeding.

White line shows the standard vertical approach. Yellow line

shows an easy alternativ e approach with the RAD-GUIDE

which almost only goes through fat . The RAD-GUIDE will

support adequately the long biopsy needle.

June, 2010TM

vertical through muscles, possibly more painful and with

CLINICAL CASE CLINICAL CASE

Product : RAD-GUIDETM

Subject : CT guided mediastinal mass biopsy with the RAD-GUIDE

Description : Patient with a right lower lobe pulmonary nodule and subcarinal adenopathy.

Histologic diagnostic was necessary and subcarinal mass biopsy was considered

Pre Biopsy CT

A yellow line is drawn from the mass

through the skin entry point (identified

by the freezing needle) and beyond the

the RAD-GUIDE to choose the best hole

in the top plate (curved white arrow).

Reference grid on patient's skin to choose

the best entry point to reach the subcarinal

mass (white arrow). The best path is to

avoid going through the lung (yellow line).

However, space is minimal along the

June, 2010

vertebral body.

easier and safer than getting samples from the small (1 cm) pulmonary nodule.

Description of the intervention

Discussion : The RAD-GUIDE supported a long biopsy needle which usually would have to be

deeply inserted before it stays still, especially in fat. This case illustrates the capacity

for the RAD-GUIDE to save you time by avoiding multiple needle repositioning. It

also gives you different and often safer approaches because any angulated

approches are made not only possible but even easy.

3 4 5

After freezing and choosing the hole

in the top plate, the guiding needle

is moved forward and supported by

the RAD-GUIDE (white arrow).

The long guiding needle is moved

forward until reaching the

adenopathy. Top plate was

dropped down allowing to easily

angulate the needle (white arrow).

Coaxial biopsy needle inserted

for adenopathy biopsy

(white arrow).

CLINICAL CASE CLINICAL CASE

Description of the intervention

Discussion :

heavy RF needles in renal masses. The RAD-GUIDE also supported 2 biopsy

needles. A sixth needle was also inserted in the lower RAD-GUIDE in order to inject

CO and dextrose to displace and avoid burning the colon.2

First RF needle. Second RF needle. Third RF needle

RAD-GUIDE (white arrow) supporting a needle used to

inject CO between the colon and the lesion (red arrow).

The use of 2 RAD-GUIDEs was necessary to insert precisely and support 3 long and

2

Product : RAD-GUIDETM

Subject : Deep abdominal abcess drainage with the RAD-GUIDE

Description : 57 Y.O. patient with previous percutaneous abcess drainage secondary to an

abdominal surgery. A second collection was considered too deep for percutaneous

drainage and treated with antibiotics. Patient came back with fever and abdominal

pain.

Diagnostic CT : White arrows show the residual abcess

Description of the intervention

Description of the intervention

Reference grid on patient's skin for choosing

entry point.

The red line drawn on CT monitor helps you to

choose the appropriate hole in the plate of the

RAD-GUIDE to easily reach the abcess.

June, 2010

CLINICAL CASE CLINICAL CASE

Product : RAD-GUIDE

Subject :Multiple radiofrequency (RF) renal tumor ablation with the RAD-GUIDE

Description : High risk surgery patient with 3 renal masses referred for percutaneous ablation.

White arrows show lesions on pre-ablation CT performed without contrast.

Description of the intervention

1 2 3

Lesion 1 is an undetermined 7 mm

nodule better seen on post-contrast

images.

Lesion 2 is a solid mass. Lesion 3 is a complex mass.

Two RAD-GUIDEs were necessary to support RF and biopsy needles in adequate orientation.

RAD-GUIDEs are seen in blue (white arrows) and 3 RF needles (black arrows).

January, 2010TM

Discussion This case illustrates the usefullness of the RAD-GUIDE

reach a deep target. The long needle had to be deeply inserted from the beginning because it

would not have entered into the CT gantry.

1

3

2

I ma ges d escrip t ion s

1- 20 cm needle was first inserted with adequate

orientation (black arrow).

2- Needle mov ed forward to reach the abcess.

3- Guidewire inserted (not shown), top plate and

needle remov ed (white arrow) and catheter inserted

over the wire. The abcess completely drained

(black arrow).

to support a long needle and directly

COPYRIGHT © 2011. CIVCO IS A REGISTERED TRADEMARK OF CIVCO MEDICAL SOLUTIONS. RAD-GUIDE IS A TRADEMARK OF CIVCO. PATENTS PENDING.

ALL PRODUCTS MAY NOT BE LICENSED IN ACCORDANCE WITH CANDADIAN LAW. PRINTED IN THE U.S.A.

800.445.6741 | 877.329.2482 | WWW.CIVCO.COM

RAD-GUIDE Clinical Case Study_WORKING_RIGHTCROPRAD-GUIDE Clinical Case Study_WORKING_LEFTCROP.pdf